CEO’s Corner: Homelessness in our City: A True Impact of the Costs

May 3, 2019

According to data from a 2017 publication from the National Law Center on Homelessness & Poverty (NLCHP), “Don’t Count on It”, the annual number of homeless individuals is 2.5 to 10.2 times greater than the numbers obtained through the national Point in Time Count ( PIT Count). In past PIT Counts of homeless persons, San Diego has been around 8,000 to 9,000+. But what if the calculation of homeless persons is far greater. Using the lower end of the methodology from the NLCHP, San Diego’s more accurate range should be around 20,000-22,500+; using the higher end of the methodology, San Diego has over 90,000 homeless persons in our County.

No matter how the numbers are sliced, San Diego County had the fourth-most homeless residents in the U.S., trailing Seattle/King County in Washington, Los Angeles County and New York City. Not a good distinction for America’s Finest City and certainly not worth splitting hairs over whose numbers are correct. Either number is a call for action.

Family Health Centers of San Diego with its 42 sites, and 23 medical clinics provided care to over 27,000 unique homeless persons in 2018.

FHCSD clinic sites that each had over 1,000 unique homeless patients in 2018 were located in the following geographic areas: Chula Vista, El Cajon, Downtown SD, North Park, Spring Valley, Hillcrest, Lemon Grove, City Heights, and Logan Heights/Barrio Logan.

In 2017, the annual San Diego Coroner’s Report stated 126 homeless people died on our streets. The number could be higher, because the Coroner’s report does not count homeless people who were under the care of a doctor when they died on the streets.

Our hospitals are “sheltering” homeless patients because they are too sick to discharge, yet not sick enough to remain in acute care settings—so they keep them– because there is no setting that qualifies as sufficient to care for the medical needs that still remain.

Homeless people are living in San Diego hospitals at a cost of $3,000 to $5,000 a day. One hospital has “sheltered” a person over 700 days; another over 170 days. Even at $4000/day the cost to taxpayers is in the millions for just two patients. Picture this— last week, one hospital system reported a one-day census of 126 homeless people!

In 2017, homeless patients accounted for 4% of all hospital discharges, with the mode age range of discharged persons from 40-59 years old if homeless, and ≥60 years old, if not homeless. Homeless people are sicker and more vulnerable than non-homeless persons.

There is no indication these numbers are improving: “Homeless patients made about 100,000 visits to California hospitals in 2017, marking a 28% rise from two years earlier, according to the most recent state discharge data. More than a third of those visits involved a diagnosis of mental illness, according to the Office of Statewide Health Planning and Development. By contrast, 6% of all hospital discharges in California during that time involved a mental health diagnosis.

Sadly, the life expectancy of the homeless population is 55 years of age— 23 years less than the less expectancy for the US as a whole.

As a City we can continue to ignore homeless persons, criticize our homeless providers for not doing more, berate politicians for ignoring four decades of a worsening problem or we can tackle the systemic problems that led us to become #4 in the nation. Here is my take on what can done, or at least where discussion and planning should start:

Develop a diamond lane process to get affordable housing projects approved through the onerous, and protracted City approval process. Affordable housing developers state it takes at least 5 years to build a project in San Diego—5 years is too long.

Utilize excess City and County land for the development of affordable housing projects.

The City and County should set a number of low-income units needed and work toward that goal.

Establish tax-credits for for-profit developers, who develop housing units and operate them for a specified period of time.

Develop an equity fund from donations, short-term tax sources, developer fees and use a non-profit foundation to manage the funds and distribution.

Stop talking about “getting people off the streets” and instead focus time and effort to develop a multi-faceted strategy needed to address systemic issues of homelessness—starting with mental health care, substance use treatment, humane medical care for HIV and other chronic conditions, and educational and trade training programs to give homeless people the ability to earn sustainable wages once they are no longer homeless.

Develop a Medical Recuperative Care Unit (not a shelter) that works with our hospitals, to take discharged homeless patients, into a 24/7 medical step-down facility at a fraction of the hospitals’ cost.

Work with legislators and state Health Department officials to develop a new category of licensing for the Recuperative Care Unit.

Develop linkages with our hardworking homeless shelter operators, so upon discharge from the Recuperative Care Units, the homeless persons have a place to go, as opposed to going back to the hospital.

Stop the loss of SRO housing, until new units of housing can be replaced.

Buy Board and Care facilities that are for-sale and sub-contract to operators, to stem the loss of housing placements, or create new housing beds. Research shows it is cheaper to prevent homelessness than to try and turnaround homelessness, once a person has been on the street for years. The Equity Fund could “own” these facilities and a work-for-ownership arrangement made with new operators, creating a source of income for the Equity Fund until pay-back is achieved.

Fund mini- homeless navigation centers, like the large one currently underway in East Village, in all areas of the County disproportionately affected by homeless persons.

Determine a Root Cause Analysis of what got us to where we are today. For example if it is found that the low-level offender release programs have driven increases in homeless numbers on City streets, demand that Social Impact Reports accompany any legislative change to reduce costs or any large scale redevelopment project. There are always down-stream impacts to any action –these must be studied and countermeasures developed for unintended consequences. Homelessness may be an unintended consequence of early release programs, closure of state institutions, loss of SRO housing, loss of board and care facilities, and more.

And finally, recognize and accept, the severe mental illness that exists on our streets. Work with the justice system, rights organizations and law enforcement to agree on a compassionate conservatorship process for homeless persons who are no longer able to care for themselves. Board and Care homes may be the answer for many who need shelter, daily supportive services, psychiatric care and 24/7 supervision.